PDF ANTHROPOLOGY OF OVERWEIGHT, AND THE - Smithsonian Institution

AnthroNotes Volume 30 No.

1

Spring 2009

THE ANTHROPOLOGY OF OVERWEIGHT, OBESITY

AND THE BODY

byPeter_J.

Brown and

_Jennifer

Sweeney

Throughout ^most

^of

^human

^{history,obesity}

^was

^not

a

common

health

problem.

It

was not even

a realistic possibility for

most people. Today,

particularly in affluentsocieties, obesityis

common and

has increased dramaticallyinrecentyears.

For example, among American

adults obesity increased61

% ^from

¹

99

¹ to

2000. Most

recentestimates classify

63% of

the adult

US

population as overweight

and 29%

asobese. Internationally,over

300

million adults are obese

and 700

million are considered

overweight

(Nishida

and Mucavele

2005).

Becauseobesity

and

overweightinvolve theinter- action

of

genetictraitswithculturallypatterned behaviors

and

beliefs, the causes

of

obesitycan best be

understood

in the context

of human

cultural

and

genetic evolution.

Behaviors that

were

adaptive in thecontext

of

past

food

scarcities

may

be maladaptivetodayin thecontext

of

af- fluence

and

foodsurpluses.

Genetic

and

cultural traits related toobesity, re-

markably common

ⁱⁿ

human

societies, areevolutionary products

of

similar selection processes related topast

food

scarcities. In a

modern

context

of food abundance, such

cultural

and

genetictraits cause

some

peopleto

add dan-

gerouslevels

of

fat tissue to theirbodies.

The

increasing prevalenceof overweight

and

obesityinthe

United

States, especiallyinchildren,has risento national attention

and

concern;infact,ithas

been

called

an

"epidemic."

Unfortunately,existingbiomedical treatmentsforthese conditionsarenoteffective

and

therisksforobesity-caused chronicdiseases arehigh. Furthermore, obesityprevention posesaspecialchallengeforPublicHealthofficialssincemeeting

thischallengenecessitatesa

more thorough

understandingof multiple

and complex

factorsofcausation.

An Anthropological Model

This

article uses

an

anthropological

model of

culture to explore

why and how

societies

have encouraged

behav- iors

and

beliefsthatpredisposeindividuals tooverweight.

This approach

has advantages over the

commonly

used undifferentiated

concept of "environment"

forgenerating hypotheses

about

behavioral causes

of

obesity. It is par- ticularlyusefulforunderstandingthesocialepidemiologi- caldistribution

of

obesity

and minimizing

the

widespread

notionthat obesity represents psychologicalfailure.

We

beginwith

two

questions:

Why do

peoplefind

itsohardtoreducetheirintake

of

fat

and

sugareven

when

themedicalrisks

and

benefits

of

adietary

change

arewell

known? Why do

peoplefinditso

hard

toexercise?

Anthropology

suggests that the

answer

to these questionsisa

complex combination of

near-universal,in-

born

preferencesforsugar

and

fat.

These

caloricallydense substances

were

rare inthe pre-agricultural

world where

preyanimalsoften carriedlittleextrafat

and

natural sugars (honey, ripe fruit)

were

very limited.

Such food

prefer- encesare

coupled

withculturalpracticesthat aresalientin shapingfoodpreferences

and

activitypatterns

from

a

young

age (Turneretal.2008). Like

many

aspects

of human

biol-

ogy and

behavior, the ultimateanswers are linkedto

our

evolutionaryheritage.

Contexts of Food Scarcity and Abundance Many

global health

problems

are related to food:

some

people are

underfed and some

people are over-stuffed.

This

striking inequalitydid not always exist. In

most of

prehistory

and

history,

food

shortages

were common;

in fact,seasonal

hunger was

a virtuallyinevitablefact

of hu-

man

life.Because

food

shortagesaffecthealth, survival

and

reproduction, they

were

a powerful evolutionary force.

Seasonalfoodavailability results ina seasonalcycleofweight loss

and weight

gain in

both hunting and

gathering

and

agriculturalsocieties.

Approximately

12,000yearsago,

some human groups

shifted

from

a

food

foraging

economy

to

one of food

production.

This economic

transformation allowedtheevolution

of complex

civilization.

The

archeo- logical recordclearly

shows

that agriculture

was

oftenas- sociatedwithnutritionalstress,

poor

health,

and

diminished

Page 6

AnthroNotes Volume 30 No.

1

Spring 2009

stature,

whether due

to tooth

decay from

increased con-

sumption of

sugars

and

carbohydrates, or

an

increase in infectious disease

from more crowded

livingconditions, oractual

food

scarcity.

Anthropological research has

demonstrated

that

food

foragers are generally healthierthan

many

lessindus- trializedpopulationsrelying

on

agriculture

-

at leastbefore they

were

displaced

from

theiroriginalterritories.

Although our food

foragingancestors sufferedrisks

of

periodic

food

shortages,they

commonly

^{enjoyedhighqualitydiets,}

low

exposureto infectiousdiseases,

and

highlevels

of

physical fitness.In addition, studies

of

traditional

hunting and

gath- eringpopulationsreport

no

obesity.

Since

food

shortages

were

ubiquitousfor

humans under

naturalconditions,selectionfavoredindividuals

who

couldeffectivelystore caloriesintimes

of

surplus.For

most

societies,

such

fatstores

would

becalled

on

at leastevery

two

to threeyears.

The

evolutionaryscenario indicates that females

with

greaterenergy reserves in fat

would have

a selectiveadvantage overtheir leancounterparts inwith- standing the stress

of food

shortage, not onlyfor

them-

selves,

but

fortheirfetusesornursingchildren.

In this evolutionary context the usual range

of

human

metabolicvariation

must

have

produced many

in- dividuals

with

apredisposition to

become

obese;yet

such

individuals

would

never

have

the

opportunity

to

do

so.

Furthermore,inthiscontext therecouldbelittleor

no

natural selectionagainstsucha

tendency

towardsfatness.Selection could

not

providefor the eventuality

of continuous

sur- plusbecauseit

had

simply neverexisted.

In contrast to a historyofscarcity,

developed

so- cietieslikethe

contemporary United

Stateshavecreated

an

obesogenicenvironment,

wherein

the physical,

economic,

social

and

cultural

environments encourage

apositiveen- ergybalanceintheirpopulation.

The

idea

of

a nutrition transition" is

one way

to explain the

emergence of

the obesogenic

environment

(Popkin 1994).

According

tothis theory, as societies

undergo

globalization,westernization

and

urbanization,their diets

change

dramatically.Post-tran- sition diets are

marked by

energy dense foods

with

high levels

of

quicklydigestible carbohydrates as wellas high levelsofdietaryfat.

Three

basic culturalchanges

accompany

such

nu-

tritiontransition:

1 Diets decreasein fiberintake

and

increase infat

and

carbohydrate

consumption,

particularly insugar

and

itssubstitutessuchashigh-fructosecornsyrup.

The

indus- trializedfood system addscalories

and

encouragesincreased

food

portion size

due

to

consumer demand and

higher profitopportunities.

2)

The

nutrition transition^isassociated

with

de- creased energy expenditures related to

work, modes of

transportation,recreation,

and

dailyactivities.Becausetech- nological changes

have reduced

requirementsfor

human

labor, peoplein

developed

societies

must burn

energyto prevent overweight

and

obesity

through

daily

workouts

ratherthandaily

work.

3)

From

the cultural perspective

of

thepopula- tions

undergoing

the nutrition transition

and economic

modernization,increasing

body

size

may

initiallybeseenas a

good

thing (rather than a health

problem)

but subse- quentlyfat

becomes

a

symbol of

lowerclassstatus.

The Problems of Obesity and Overweight Throughout most of human

history, obesity

was

nevera

common

health

problem. Today

it is

common and

has increaseddramaticallyin recentyears.

Not

onlyare over-

weight and

obesityrelatively

common

conditions in

our

society, but they are also extremely

complex and

intrac- table.

Obesity

^is a serious public health

problem

not becauseitisa diseaseitselfbut becauseitisassociated

with major

causes

of morbidity and

mortality

from

chronic diseases.

These

include cardiovascular disease, type-two diabetesmellitus,hypertension,

and some

cancers.Cardio- vascular disease is the

most common

cause

of

death in developedcountries.

The

directrelationship

between

overweight

and

healthis

under

debate,asphysicalactivity

may

actuallybe

more important

to healththan

body

weight.

On

the indi- vidual level, obesity

and

overweight bring

with them an enormous amount

ofpersonal psychological pain.

The

fact thattheobesearesubjected to significantsocial

and

eco-

nomic

discriminationiswell

documented.

Fatisextraordinarilydifficulttoshedbecause the

body

guardsitsfat stores.

The

remarkablefailureofdiettherapies has

made some

researchersrethink thecommonsensicaltheory ofobesityasbeingsimply caused

by

overeating.Clinical evi-

AnthroNotes Volume 30 No.

1

Spring 2009

dence ofthe pastfortyyearssimply doesnot support

such

a simplistic notion. Increasingly, obesity

and

overweightare beinglinked to physicalinactivity

and

metabolic

pathways

that lead to excessfatstorage related to

modern

diets.

Even

in the absence of

good

scientific dataabout theeffectivenessofdiettherapy,thediet

and

weightlossin- dustryinthe

United

Statesisremarkablysuccessful incaptur- ing the

hope and money

of people

who

perceivethemselves tobeoverweight.Thisindustrythrivesbecauseofa

complex

ofculturalbeliefsabouttheideal

body and

sexualattractive- nessratherthan medicaladvice

and

thepreventionofchronic diseasesperse.

The American

culturalconcern about weight

loss

and

the positive value placed

on

slenderness

among American middle and upper

class

women

isdifficulttoover- emphasize.

Chernin

(1985)hasreferred tothiscultural

dieme

asan"obsession"

and

the"tyrannyofslenderness."

Within

thiscontext,it isimpossibletoclaimthatoverweight

and

obe-

sityarepurelymedicalissues.

Changing Definitions of Obesity

Many

basicscientific issuesregardingobesityare,infact, controversial.Obesityissimply"excessadiposetissue,"but

most

measuresin

medicine and

public health

cannot mea-

sure this directly. Definitions

of

obesity

and

overweight are partly

debated

because theyare based

upon

inferred definitions

of

normality or "ideal"

body

proportions.

Current

medicalliteratureutilizes

Body Mass

Index

(BMI)

defined as

body weight

divided

by

height squared.

BMI (W/H2)

^iscorrelatedwithtotal

body

fat,

and

a

BMI

greater than

30

isgenerallyconsideredobese.

However, muscular

athletes

have

high

BMIs

be- cause

muscle mass weighs more

thanfat.

BMI

^iscurrently usedin clinicalsettings forindividual patientseven

though

it

was

developedasapopulation-levelmeasure;

some

schol- arsbelievethisis

an

inappropriateuse.Also,

BMI

measures

may

not beappropriately validinallpopulations.Increased risk

of

chronic disease affects

some Chinese and South

Asian populations atlower

BMIs

than

among European

populations.

An important and

often neglected

dimension

to definingobesity involvesthe distributionoffat

around

the

body trunk

or

on

the limbs. Central or truncal

body

fat distribution iscloselycorrelated

with

serious chronicdis- easeslikecardiovasculardisease,whileperipheral

body

fat inthehips

and

limbsdoesnotcarry similarmedicalrisks.

In other words, peripheral

body

^{fat typical}

^of women

appears to be epidemiologically benign.

Because of

this clinically

important

distinction,

measures of

fatdistribu- tionlikewaist tohipratio

(WHR), wherein

lower

WHR

indicateslowerrisk

of

chronicdiseaseconsequences,area valuable additiontothe

measurement of

obesity.

Increased

morbidity due

to diseaseisseenat

both

extremes

of

the

BMI

spectrum.

Very low BMI —such

asis

seeninpartsofthedeveloping

world

likeIndia

—

^increases

risk

of

deaths

due

to infectious diseasesbecause

of

alack

of

energy reserves.

At

the higher end,

BMI

is linked to chronicdiseasesincludingcoronaryheartdisease,highblood pressure, stroke, type-two diabetes mellitus,

and

a range

of

cancers.

Both

high

and low BMIs

are associated

with poor

health,

whereas "normal"

^levels

of

adiposity (fat)

should includearange

of body

types.Itisparticularly

im-

portanttonotethatlevels

of

physical inactivity arelinked to

poor

health

outcomes more

stronglythanare

body

size or weight; inotherwords,itispossible to

be

fit

and

fat.

Biological

and Cultural

Perspectives

on the Body The nonrandom

socialdistributionofadipositywithin

and between human

populations

may

providea

key

tounder- standingobesity. Inaddition to thecircumstances

of

the nutrition transitiondiscussedabove, three features

of

the socialdistribution

of

obesity are particularlycogentfor

an

anthropological analysis: one, a

gender

difference in the total percent

and

sitedistribution

of body

^fat, aswell as theprevalence

of

obesity; two, the concentration

of

obe-

sityincertainethnicgroups;

and

three,apowerful

and com-

plex relationship

between

social class

and

obesity.

Any

use- fultheoryconcerningthe etiology(origins)

of

obesity

must

help

account

forthesesocialepidemiologicalpatterns.

SexualDimorphism

Humans show

only mildsexualdimor-

phism

in stature:malesareonly5to9 percenttallerthanfe- males.

Men

are largerthan

women

inheight

and

total

body

mass,but

women

have

more

subcutaneousfat.

However,

the greatestdegreeofsexual

dimorphism

is

found

inthedistri-

butionoffat tissue,with

women

having

much more

periph- eral fatinthelegs

and

hips.Thisdifferenceisepidemiologically important.

With

the

same BMI,

the greaterproportion

of

peripheralfatnessinfemales

may

beassociatedwith reduced morbidity

and enhanced

fertility,whereas

more

central

body

fat

may pardy

explainhigher cardiovasculardisease rates

and

lowerlifeexpectanciesinmales.

Page 8

10 20 30 40 50

PERCENT FEMALES OBESE

o

DEVELOPED

•

UNDERDEVELOPED

Gender

differencesinprevalencesofobesityin14 populations by general industrial

development. The unbroken

line

demarcates

equal male-female obesity prevalences.

The

broken line indicates an apparent distinction in

gender

proportions of obesity in developed and underdeveloped countries.

From

Brown,P.J.,andM.Konner,

An

Anthropological PerspectiveonObesity. In R.J.

Wurtman,

andJ. J.

Wurtman,

eds.,

Human

Obesity,Annalsof

New

York

Academy

ofSciences 499:29-46. Copyright 1987. Reprinted with permission.

Sexdifferences arealso seen in theprevalence

of

obesity.

Data from

the

14

population surveys

shown

in Figure

2

indicate that in all

of

thestudiesfemales

have

a higher prevalence

of

obesitythan males. Despite contro- versies

concerning measurement,

a greaterriskforobesity forfemales appears to be abasic fact

of human

^biology.

Evolution has favored female ancestors

who

are abletoretainsurplus

body

fat,thus

improving

their ability tobear

and

feedchildrenevenintimes

of

nutritionalscar- city. Peripheral

body

^{fat ismobilized} afterbeing

primed with

estrogen

during

thelatestagesof

pregnancy and

lac- tation. In addition, a

minimal

level

of

female fatnessin- creasesreproductivesuccessbecause

of

itsassociation

with

regularcyclingaswellas earlier

menarche.

Fat

metabolism

isinfluenced

by hormones

including reproductive

hormones and

insulin.

Pregnancy and

lactationrepresentserious

and

con- tinuingenergy

demands on women

in societiesthathave not

undergone

the

demographic

transition

-

thehistoricalshift

from

highto

low

fertilityratesassociatedwiththereduction ofmortality

due

to infectious disease.Inunderdevelopedso- cietieswith highfertility,higher

numbers

ofpregnancies

and

longer periodsofbreastfeeding placehighenergy

demands

upon women,

especiallyiftheycannot

supplement

theirdiet.

As

aresult,such

women

suffergreaterriskofprotein-energy malnutrition.Conversely,withfewer pregnancies

and

there-

ductionofbreast-feeding,

women

indevelopedsocietieshave

lessopportunitytomobilizeperipheralfatstores

and

suffer greaterriskofobesity

(Worthman

etal. 1989).

Ethnicity

The

idea that particularpopulations

have

high rates

of

a

genotype

thatpredisposesindividuals to obesity

and

related diseasesisnot new,

and

is

supported by

acon- vincing

body of adoption and

twindata, aswell as

work

focusing

on

obesity-pronepopulationslikethe

Pima

Indi- ans.

This

isevidence

of

geneticpredisposition toobesity.

Inthe

United

States,ethnic

groups with

elevatedrates

of

obesity include:African

Americans

(particularlyintherural south),

Mexican Americans,

Puerto Ricans,

and

Native

Americans. Given

thatthese

groups

areoften over-repre- sentedinlower

socioeconomic

strata,it

may

bedifficultto distinguishthe causaleffectsofclassversusethnicity.

The

factthat certainethnicgroups

have

highrates

of

obesityis

noteasy to interpretbecause

of

the

entanglement of

the effects ofclass

with

genetic heredity, culturalbeliefs,

and

opportunitiesforexercise.

Socialclass

Socioeconomic

status isapowerful predictor

of

the prevalence

of

obesity in

both modernizing and

affluentsocieties,althoughthe direction

of

the association varieswiththetypeofsociety.Indevelopingcountries there

isastrong

and

consistent positive association

of

social class

and

obesity for

men, women, and

children.

Correspond-

ingly, there is

an

inverse correlation

between

social class

and

protein-caloriemalnutrition.

On

theotherhand,ithas long

been

recognizedthat in heterogeneous

and

affluent societies likethe U.S., thereisastronginversecorrelation

of

social class

and

obesity for females.

The

association of obesity

and

social class

among women

inaffluentsocieties

isnotconstantthroughthelifecycle.

Garn and

Clark(1976) have

demonstrated

apattern

of

reversalin

which economi-

callyadvantagedgirlsareinitiallyfatterthantheir

poor

coun- terparts.Forfemales,social classremainsthe strongestso- cialepidemiologicalpredictor ofobesity.

Cultural Perceptions of Body

Size

From an

anthropologicalperspective,the

most

importantas- pectsofculturerelatingto

body

weight

may

becultural

sym-

bols, beliefs

and

values.Aspects ofideology relevanttothe

AnthroNotes Volume 30 No.

1

Spring 2009

etiologyofobesity include thesymbolic

meaning of

fatness, ideal

body

types,

and

perceivedrisks

of

future

food

short- ages.Fatnessissymbolically linked to psychological

dimen-

sions

such

as "self

worth" and

sexuality in

many of

the world'ssocieties, butthenature

of

that

symbolic

associa- tionisnotconstant.In

mainstream

U.S.culture,obesityis

sociallystigmatized, butfor

many

^cultures

^of

theworld, fatnessis

viewed

asa

welcome

sign

of

health

and

prosper-

ity.

Given

therarityofobesityinpreindustrialsocieties,it is

notsurprising thatethnomedical termsforobesity areusu-

allynon-existent.

Perhaps it is large

body

size rather than obesity persethatis

an admired symbol of

health, prestige,pros- perity or maternity.

The

agricultural

Tiv of

Nigeria, for example,distinguish

between

averypositivecategory"too big"(kehe)

and

anunpleasantcondition"to

grow

fat"{ahon).

The

firstisa

compliment

becauseitisasignofprosperity;

the

second term

is a rare

and

undesirable condition. For

women,

^fatness

may

also

be

a

symbol of

maternity, nurturance,

and

adultsuccess.Symbolically, afat

woman

^is

well taken care of, and, in turn, takes

good

care of her children.

The

ethnographic recordindicatesthatFellahin

Arabs

in

Egypt

describetheproper

woman

^asfatbecause she has

more room

to bear a child, lactates abundantly,

and

gives

warmth

toherchildren. Incontrast,the cultural ideal

of

thinness in

developed

societies is

found where motherhood

^is neither thesole

nor primary means

ofsta- tus attainment for

women. The

ideas that fatbabies are beautiful

and

thatfatchildrenarehealthychildren arevery widespreadthroughouttheworld.Foods,particularlysweet foods, can be treatedas

symbols of

love

and

nurturance

on

the part

of

parents

and

grandparents; the

growing problem

ofchildobesityin

China

is related to increased

economic

resources,theone-childpolicy,

and

doting grand- parents.In

some

culturesit

may

be impoliteforaguestto refuse

some

offered food,

but

it is taboo to refuse

food from ones

mother.

Fatness and CrossCultural Standards of Beauty

Culturallydefined standards

of

beauty for

women

vary

between

societies

and may

have

been

a factor inthe sexual selection for

phenotypes

predisposedtoobesity.

A

classic

example

is the

custom of

"fatteninghuts" foreliteEfik

pubescent

girlsintraditionalNigeria.

Here

fatness

was

a

primary

criterion

of

beautyasdefined

by

theelites,

who

alone

had

the

economic

resources to participate inthiscus-

tom. An important

recent

ethnography of Azawagh

Ar- abs

of Niger

entitledFeedingDesire(Popenoe,

2004)

illus- trates these culturalnotions to

an extreme

degree. Here, fatness to thepoint

of voluptuous immobility

is encour-

aged by

systematicover-eating inordertohastenpuberty,

enhance

sexuality,

and

ripengirlsformarriage.

The

people believe that

women's

bodies

should

be fleshy

and

laced

with

stretch-marks in orderto contrast

with

thin,

male

bodies. Similarly, fatter brides (as wellas early

maturing

brides)

demand

significantlyhigherbridewealth

payments among

the Kipsigis

of Kenya. The Tarahumara of

north- ern

Mexico

consider fatlegsa

fundamental

aspectofthe ideal

feminine

body; a

good-looking woman

^is called a

"beautiful thigh."

Ramotswe,

the large

and

beautifulpro- tagonist

of

apopular

mystery

series

by Smith

(2009)setin

Botswana,

isreferred toas"traditionallybuilt."

Among

the

Amhara of

the

Horn of

Africa, thin female hips are called

"dog

hips" in a typical insult,

and

thin

women

in

Jamaica

are

thought

tobe

meager and pow-

erless,likea

mummy

oradried

empty

husk. YetinBelize

body

shapeis

more important

than

body

size,

with most

peoplepreferring

women

to

have

acurved, hourglassfig-

urelikea

Coca-Cola

or

Fanta soda

bottle.

Among

the world'scultures,itisdifficultto

know how

widespreadisthe associationof

plumpness and

beauty.

Zeinabou, considered very beautifulinthe

Azawagh

Arab

culture.

Tassara, Niger, 1991. Photo courtesy Rebecca Popenoe.

Page 10

A preliminary indication can be found through

a crossculturalsurvey based

upon

the

Human

Relation

Area

Files (across-indexedcompilation

of

ethnographicinfor-

mation on

over

300 of

the

most thoroughly

studiedsoci- eties).

This

dataoffersthebasisfor

some

preliminary gen- eralizations,notablythat culturalstandards

of

beauty tend nottorefertophysical extremes.

On

theother

hand,

the desirability

of "plumpness"

orbeing"filledout"is

found

in 81 percent

of

thesocieties.

This

standard,

which

prob- ably includes theclinicalcategories

of

overweight

and mild

obesity,apparentlyreferstothedesirability

of

fatdeposits, particularly

on

the hips

and

legs.

Although

crossculturalvariation in standards

of

beautyisevident,thisvariationfallswithina certainrange.

American

ideals

of

thinnessoccurin a setting

where

it is

easy to

become

fat,

and

preferencefor

plumpness

occurs insettings

where

itiseasy to

remain

lean.Incontext,

both

standards requiretheinvestment

of

individualeffort

and economic

resources;furthermore,eachinits

own

context involves a display

of

wealth.Culturalbeliefs

about

attrac- tive

body

shapein

mainstream American

cultureplacepres- sure

on

females to lose weight; such cultural beliefs are central tothe etiology

of

anorexia nervosa

and

bulimia.

Ideal

Male Body Type,

Size,

and Symbolic Power The

ethnographic record

concerning body

preferences in malesisweak,yetpreliminaryresearch suggests a universal preferencefora

muscular physique and

fortallor

moder-

atelytall stature.

Men

tendtoaspire to a

muscular

shape characterized

by

well-developed

upper body

muscles

and

slimwaist

and

hips.Efforts toachievethisideal

body

gen- erallycenter

around

exerciseratherthandiet.

Large

body

size

may

serve as

an

attribute

of

at- tractivenessin

men

because^itsymbolizeshealth,

economic

success, politicalpower,

and

social status."Big

Men,"

the political leaders in tribal

New Guinea,

are described

by

theirconstituents interms

of

their size

and

physical well- being:

he

isa

man "whose

skin swells

with

'grease' [orfat]

underneath"(Strathern 1971).

The

spiritual

power

(jnana)

and

noble breeding

of

a Polynesian chief areexpected to bereflectedin hislargephysicalsize. In

American

society there arehistoricalvestiges

of

a similaridea,forexample,a

"fat cat" isa

wealthy and powerful man who

can

"throw

hisweight around."

Contemporary

rap

and hip-hop

isfilledwithposi- tive references to large bodies indicating largesse in life,

FemaleSilhouettes

f f ^ft f

MaleSilhouettes

f # # t

Figure 1 ThesilhouettesusedInthe perceptionofbodysize(1—thin, 2

=

normal, 3=overweight,4=obese).

IllustrationcourtesyD. T.Simeon.PublishedinSimeon,D.T.,et

al. 2003.

especially in

names

suchastheNotoriousB.I.G.,

Heavy D, and

the FatBoys.

Most male

collegestudentsinthe U.S.,in contrastto

women, want

togainweight becauseit isequiva- lent togaining

muscle mass and

physical

power

in apro- cesscalled"bulking up."

Concl ^nciusions

Three

conclusions can

be drawn from

^this discussion of culture

and

itsrelationship toobesity.

• First, recognition

of

cultural variation inbeliefs

and

be- haviors related to obesity needs to be incorporated into health

programs aimed

atreducingtheprevalence

of

obe-

sity.

•Second,

more

educationis

needed about

the

importance of

the location

of body

fat(ratherthansolely

BMI)

aswell as the medical benefits

of

increased physical activity re- gardless

of body

size.

• Third,

more

research is necessary

on

therole

of

culture asitinteractswithgenes,

on

the etiology

of

obesity,

and on

associatedchronicdiseases.

Existingcultural beliefs

must

be takenintoaccount in the design

and implementation of

health

promotion

projects.

A

^classic

example

^is

an

obesityprevention

cam-

paign ina

Zulu community

outside

of Durban (Gampel

1962).^Itfeatured

one

healtheducationposter thatdepicted

an

obese

woman and an

overloaded truck

with

aflat tire,

with

acaption

"Both

carry too

much

weight."

Another

poster

showed

aslender

woman

easily

sweeping under

a tablenext to

an

obese

woman who

^{is using} the table for support; ithas the caption,

"Who do you

prefer to

look

AnthroNotes Volume 30 No.

1

Spring 2009

like?"

The

intended

message of

these posters

was

misin- terpreted

by

the

community

because

of

a cultural

connec-

tion

between

obesity

and

social status.

The woman

inthe

firstposter

was

perceivedto be rich

and

happy, sinceshe

was

not only fat but

had

a truck overflowing

with

her possessions.

The second

poster

was

perceived as a scene

of an

affluentmistress directingher

underfed

servant.

Healthinterventions

must

beculturallyacceptable,

and

in thisregard

we cannot assume

thatpeopleplacethe highest priority

on

theirhealthor

on

theirphysicalappear- ance.

Many

people at risk

of

obesitylive in poverty, or have a history

of

poverty,

and

therefore feel insecure re- gardingpossiblefuturefoodshortages. Similarly,eatinghigh calorie

comfort

foods can bea psychological adaptation tostressfullivingconditions.Finally,disadvantagedpeople

may

discounttheirfutures

—

thatis,ignore

somewhat

vague

risks

of

futurechronicdiseaseassociatedwithobesity

when

they

do

notfeel

empowered and

livein a

fundamentally

risky world.

The

social distribution

of

overweight

and

obesity

may

^reflectsocialinequalitiesaswellasa

changing

"obesogenic"

environment.

The

frequency

of

past

food

shortages, thesocial distribution ofobesity,

and

the cultural

meanings of

fat- ness,

when

takenaltogether,suggest a biocultural

hypoth-

esis

of

theevolution

of

obesity.

Both

genetic

and

cultural predispositions to obesity

may

be products

of

the

same

evolutionarypressures,involving

two

relatedprocesses.First, genetictraitsthatcausefatness

were

selectedbecause they

improved

chances

of

survival in the face

of food

scarci- ties,particularly forpregnant

and

nursing

women.

Second, inthecontext

of unequal

access to food, fatness

may have been

socially selected because it is a cultural

symbol of

socialprestige

and an

index

of

general health.

Under West-

ern conditions of

abundance, our

biological

tendency

to regulate

body weight

at levels

above our

ideal

weight

can- not

be

easilycontrolled even

with

a reversal

of

thewide- spreadculturalidealof

plumpness.

Recent advancesinunderstandingthe genetic bases ofobesity are

echoed by new

understandings

about

the role

of

"environment."

Recent

research into the role

of urban

sprawl,thebuilt

environment, and

resultingseden- tary

modern

lives demonstrates that decreasingphysical activityhascontributedto currentlevels

of

overweight

and

obesity.

Despite increased

understanding of

the etiology

of overweight and

obesity, as well as the

combined

bioculturalcontributions to the conditions,

many

questions

and

avenues for futureanthropological research remain.

These

include:socialdiscrimination againstfatpeople,even

when

themajorityofapopulationisfat;relativeinfluences

of

dietary

change and

decreasedphysicalactivityinobe-

sity;

changing

culturalstandards

of body

ideals

and

physi- calactivityrelated to acculturation

and

classmobility;the culturalperceptionofthemedical

community,

particularly obesity researchers; cultural patterns

of accommodations

for

an

increasinglyfat

and

less

mobile

population;

and

un- derstanding

of

the cultural beliefs

and

behaviors

of

indi- viduals or

groups who

aresuccessful inreducingrisksfor chronicdisease

through

sustainedweightloss.

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Jennifer

Sweeney a

doctoralcandidate at

Emory

University,Atlanta, Georgia.

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